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Republic of the Philippines

Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2017 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Aurora Central School
SCHOOL CODE/ID 103072
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Aurora/Sta. rosa
REGION II

ITEM NO. DESCRIPTION REMARKS


J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing Completed
J.1 bars
J.2 Tie beam Completed
4" floor slab on fill with 10mm dia. Reinforcing bars Completed
J.3
Concrete waiting area(4" thick reinforced concrete
with 12mm dia. Reinforcing bars at 600mm spacing Completed
J.4
bothways)
J.5 Concrete ramp Completed

A. FLOOR FINISHES
A.1 Floor Finishes Completed
B. WALLS
B.1 Wall Panels with Insulation Completed
C. CEILING
C.1 Ceiling Panels Completed
D. FURNISHINGS
D.1 Reception Counter with chair(1) Completed
Health Worker's Counter with chair (1), visitor's Completed
D.2 chair(2)
D.3 Waiting Area - metal bench with rest(2) Completed
D.4 Examining bed(2) Completed
Nebulizer Not yet delivered
Non contact forehead thermometer Not yet delivered
Digital sphygmomanometer Not yet delivered
Dressing set Not yet delivered
E. COUNTERS AND CABINET WORKS, SIGNAGE
Completed
E.1
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) Completed
F. DOORS AND WINDOWS
Sliding glass windows on metalframe, with aluminum Installed/No aluminum screen & locks are brok
F.1
screen
Steel Doors - entrance door with aluminum screen Installed/No aluminum screen door
F.2 door
F.3 Steel Doors - all interior doors Installed
G. PAINTING WORKS
G.3 PAINTING WORKS Completed/ Repaint rusty square columns
H. ROOFING WORKS WITH TRUSS / RAFTER
Completed
H.1 Ribbed, pre - painted metal galvanized Iron sheets
with steel rafters, with insulation
I. STAIRS/RAMP
50mm dia x 3.6m handrail, stainless steel for main Completed/ Repair unstable steel handrail @ ra
I.1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits Completed
K.2 Ceiling fan (4pieces) Completed
K.3 Convinience outlets Completed
K.4 18 watts led light fixture with switches Installed
K.5 Emergency lights Installed
L. PLUMBING/ SANITARY WORKS
Installed
L.1 Wc Tank type Lever type Flush w/ complete fittings
and accessories
Lavatory complete with spray faucet, fittings and Installed/ no p-trap
L.2 accessories

Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. Installed/ no p-trap
L.3
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) Not Yet Installed
Installed
L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap)
(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted Installed
Hose Bibb( at right side of building beside the toilet) Installed
L.7

L.8 Soap Holder Installed


L.9 Stainless steel grabrail at toilet Installed
L.10 Prefabricated Septioc Tank System Installed

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer I Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
mitted: March , 2017

School Sites- Phase 1

EMARKS

ompleted

ompleted
ompleted

ompleted

ompleted

ompleted

ompleted

ompleted

ompleted
ompleted

ompleted
ompleted
et delivered
et delivered
et delivered
et delivered
ompleted

ompleted

m screen & locks are broken

uminum screen door

nstalled

int rusty square columns

ompleted

stable steel handrail @ ramp


ompleted
ompleted
ompleted
nstalled
nstalled

nstalled

ed/ no p-trap

ed/ no p-trap

Yet Installed
nstalled

nstalled
nstalled

nstalled
nstalled
nstalled

MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2016 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Cañogan Elementary School
SCHOOL CODE/ID 103066
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Sto. Tomas/Cañogan
REGION II

ITEM NO. REMARKS


J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing Completed
J.1 bars
J.2 Tie beam Completed
4" floor slab on fill with 10mm dia. Reinforcing bars Completed
J.3
Concrete waiting area(4" thick reinforced concrete
with 12mm dia. Reinforcing bars at 600mm spacing Completed
J.4
bothways)
J.5 Concrete ramp Completed

A. FLOOR FINISHES
A.1 Floor Finishes Completed
B. WALLS
B.1 Wall Panels with Insulation Completed/Dirty
C. CEILING
C.1 Ceiling Panels Completed
D. FURNISHINGS
D.1 Reception Counter with chair(1) Completed
Health Worker's Counter with chair (1), visitor's Completed
D.2 chair(2)
D.3 Waiting Area - metal bench with rest(2) Completed
D.4 Examining bed(2) Completed
Nebulizer Not yet delivered
Non contact forehead thermometer Not yet delivered
Digital sphygmomanometer Not yet delivered
Dressing set Not yet delivered
E. COUNTERS AND CABINET WORKS, SIGNAGE
Completed
E.1
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) Completed
F. DOORS AND WINDOWS
Sliding glass windows on metalframe, with aluminum Installed/No aluminum screen & locks are broken
F.1
screen
Sttel Doors - entrance door with aluminum screen Installed/No aluminum screen door
F.2 door
F.3 Steel Doors - all interior doors Installed
G. PAINTING WORKS
G.3 PAINTING WORKS Completed/ Repaint rusty square columns
H. ROOFING WORKS WITH TRUSS / RAFTER
Completed
H.1 Ribbed, pre - painted metal galvanized Iron sheets
with steel rafters, with insulation
I. STAIRS/RAMP
50mm dia x 3.6m handrail, stainless steel for main Completed/ Repair unstable steel handrail @ ramp
I.1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits Completed
K.2 Ceiling fan (4pieces) Completed
K.3 Convinience outlets Completed
K.4 18 watts led light fixture with switches Installed
K.5 Emergency lights Installed
L. PLUMBING/ SANITARY WORKS
Installed
L.1 Wc Tank type Lever type Flush w/ complete fittings
and accessories
Lavatory complete with spray faucet, fittings and Installed
L.2 accessories

Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. Installed/no P-trap
L.3
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) Installed
Installed
L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap)
(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted Installed
Hose Bibb( at right side of building beside the toilet) Installed
L.7

L.8 Soap Holder Not Yet Installed


L.9 Stainless steel grabrail at toilet Installed
L.10 Prefabricated Septioc Tank System Installed
Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer I Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
mitted: March , 2017

School Sites- Phase 1

EMARKS

ompleted

ompleted
ompleted

ompleted

ompleted

ompleted

pleted/Dirty

ompleted

ompleted
ompleted

ompleted
ompleted
et delivered
et delivered
et delivered
et delivered

ompleted

ompleted

m screen & locks are broken

uminum screen door

nstalled

int rusty square columns

ompleted

stable steel handrail @ ramp

ompleted
ompleted
ompleted
nstalled
nstalled

nstalled

nstalled

ed/no P-trap

nstalled
nstalled

nstalled
nstalled

Yet Installed
nstalled
nstalled
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2017 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Antagan Elementary School
SCHOOL CODE/ID 103887
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Tumauini/Antagan 1st
REGION II

ITEM NO. DESCRIPTION REMARKS


J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing Completed
J.1 bars
J.2 Tie beam Completed
4" floor slab on fill with 10mm dia. Reinforcing bars Completed
J.3
Concrete waiting area(4" thick reinforced concrete
with 12mm dia. Reinforcing bars at 600mm spacing Completed
J.4
bothways)
J.5 Concrete ramp Completed

A. FLOOR FINISHES
A.1 Floor Finishes Completed
B. WALLS
B.1 Wall Panels with Insulation Completed/Dirty
C. CEILING
C.1 Ceiling Panels Completed
D. FURNISHINGS
D.1 Reception Counter with chair(1) Completed
Health Worker's Counter with chair (1), visitor's Completed
D.2 chair(2)
D.3 Waiting Area - metal bench with rest(2) Completed
D.4 Examining bed(2) Completed
Nebulizer Not yet delivered
Non contact forehead thermometer Not yet delivered
Digital sphygmomanometer Not yet delivered
Dressing set Not yet delivered
E. COUNTERS AND CABINET WORKS, SIGNAGE
Completed
E.1
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) Completed
F. DOORS AND WINDOWS
Sliding glass windows on metalframe, with aluminum Installed/No aluminum screen & locks are broken
F.1
screen
Sttel Doors - entrance door with aluminum screen Installed/No aluminum screen door
F.2 door
F.3 Steel Doors - all interior doors Installed
G. PAINTING WORKS
G.3 PAINTING WORKS Completed/ Repaint rusty square columns
H. ROOFING WORKS WITH TRUSS / RAFTER
Completed
H.1 Ribbed, pre - painted metal galvanized Iron sheets
with steel rafters, with insulation
I. STAIRS/RAMP
50mm dia x 3.6m handrail, stainless steel for main Completed/ Repair unstable steel handrail @ ramp
I.1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits Completed
K.2 Ceiling fan (4pieces) Completed
K.3 Convinience outlets Completed
K.4 18 watts led light fixture with switches Installed
K.5 Emergency lights Installed
L. PLUMBING/ SANITARY WORKS
Installed
L.1 Wc Tank type Lever type Flush w/ complete fittings
and accessories
Lavatory complete with spray faucet, fittings and Installed
L.2 accessories

Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. Installed/no P-trap
L.3
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) Not Yet Installed
Installed
L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap)
(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted Installed
Hose Bibb( at right side of building beside the toilet) Installed
L.7

L.8 Soap Holder Installed


L.9 Stainless steel grabrail at toilet Installed
L.10 Prefabricated Septioc Tank System Installed
Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer I Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
mitted: March , 2017

School Sites- Phase 1

EMARKS

ompleted

ompleted
ompleted

ompleted

ompleted

ompleted

pleted/Dirty

ompleted

ompleted
ompleted

ompleted
ompleted
et delivered
et delivered
et delivered
et delivered

ompleted

ompleted

m screen & locks are broken

uminum screen door

nstalled

int rusty square columns

ompleted

stable steel handrail @ ramp

ompleted
ompleted
ompleted
nstalled
nstalled

nstalled

nstalled

ed/no P-trap

Yet Installed
nstalled

nstalled
nstalled

nstalled
nstalled
nstalled
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2017 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Alicia East Central School
SCHOOL CODE/ID 102995
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Alicica/Paddad
REGION II

ITEM NO. DESCRIPTION REMARKS


J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing Completed
J.1 bars
J.2 Tie beam Completed
4" floor slab on fill with 10mm dia. Reinforcing bars Completed
J.3
Concrete waiting area(4" thick reinforced concrete
with 12mm dia. Reinforcing bars at 600mm spacing Completed
J.4
bothways)
J.5 Concrete ramp Completed

A. FLOOR FINISHES
A.1 Floor Finishes Completed
B. WALLS
B.1 Wall Panels with Insulation Completed/Dirty
C. CEILING
C.1 Ceiling Panels Completed
D. FURNISHINGS
D.1 Reception Counter with chair(1) Completed
Health Worker's Counter with chair (1), visitor's Completed
D.2 chair(2)
D.3 Waiting Area - metal bench with rest(2) Completed
D.4 Examining bed(2) Completed
Nebulizer Not yet delivered
Non contact forehead thermometer Not yet delivered
Digital sphygmomanometer Not yet delivered
Dressing set Not yet delivered
E. COUNTERS AND CABINET WORKS, SIGNAGE
Completed
E.1
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) Completed
F. DOORS AND WINDOWS
Sliding glass windows on metalframe, with aluminum Installed/No aluminum screen & locks are broken
F.1
screen
Sttel Doors - entrance door with aluminum screen Installed/No aluminum screen door
F.2 door
F.3 Steel Doors - all interior doors Installed
G. PAINTING WORKS
G.3 PAINTING WORKS Completed/ Repaint rusty square columns
H. ROOFING WORKS WITH TRUSS / RAFTER
Completed
H.1 Ribbed, pre - painted metal galvanized Iron sheets
with steel rafters, with insulation
I. STAIRS/RAMP
50mm dia x 3.6m handrail, stainless steel for main Completed/ Repair unstable steel handrail @ ramp
I.1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits Completed
K.2 Ceiling fan (4pieces) Completed
K.3 Convinience outlets Completed
K.4 18 watts led light fixture with switches Installed
K.5 Emergency lights Installed
L. PLUMBING/ SANITARY WORKS
Installed
L.1 Wc Tank type Lever type Flush w/ complete fittings
and accessories
Lavatory complete with spray faucet, fittings and Installed/no P-trap
L.2 accessories

Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. Installed/no P-trap
L.3
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) Not Yet Installed
Installed
L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap)
(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted Installed
Hose Bibb( at right side of building beside the toilet) Installed
L.7

L.8 Soap Holder Installed


L.9 Stainless steel grabrail at toilet Installed
L.10 Prefabricated Septioc Tank System Installed
Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer I Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
mitted: March , 2017

School Sites- Phase 1

EMARKS

ompleted

ompleted
ompleted

ompleted

ompleted

ompleted

pleted/Dirty

ompleted

ompleted
ompleted

ompleted
ompleted
et delivered
et delivered
et delivered
et delivered

ompleted

ompleted

m screen & locks are broken

uminum screen door

nstalled

int rusty square columns

ompleted

stable steel handrail @ ramp

ompleted
ompleted
ompleted
nstalled
nstalled

nstalled

ed/no P-trap

ed/no P-trap

Yet Installed
nstalled

nstalled
nstalled

nstalled
nstalled
nstalled
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2017 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Rizalina Primary School
SCHOOL CODE/ID 103074
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Aurora/Rizalina
REGION II

ITEM NO. DESCRIPTION REMARKS


J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing Completed
J.1 bars
J.2 Tie beam Completed
4" floor slab on fill with 10mm dia. Reinforcing bars Completed
J.3
Concrete waiting area(4" thick reinforced concrete
with 12mm dia. Reinforcing bars at 600mm spacing Completed
J.4
bothways)
J.5 Concrete ramp Completed

A. FLOOR FINISHES
A.1 Floor Finishes Completed
B. WALLS
B.1 Wall Panels with Insulation Completed/Dirty
C. CEILING
C.1 Ceiling Panels Completed
D. FURNISHINGS
D.1 Reception Counter with chair(1) Completed
Health Worker's Counter with chair (1), visitor's Completed
D.2 chair(2)
D.3 Waiting Area - metal bench with rest(2) Completed
D.4 Examining bed(2) Completed
Nebulizer Not yet delivered
Non contact forehead thermometer Not yet delivered
Digital sphygmomanometer Not yet delivered
Dressing set Not yet delivered
E. COUNTERS AND CABINET WORKS, SIGNAGE
Completed
E.1
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) Completed
F. DOORS AND WINDOWS
Sliding glass windows on metalframe, with aluminum Installed/No aluminum screen & locks are broken
F.1
screen
Sttel Doors - entrance door with aluminum screen Installed/No aluminum screen door
F.2 door
F.3 Steel Doors - all interior doors Installed
G. PAINTING WORKS
G.3 PAINTING WORKS Completed/ Repaint rusty square columns
H. ROOFING WORKS WITH TRUSS / RAFTER
Completed
H.1 Ribbed, pre - painted metal galvanized Iron sheets
with steel rafters, with insulation
I. STAIRS/RAMP
50mm dia x 3.6m handrail, stainless steel for main Completed/ Repair unstable steel handrail @ ramp
I.1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits Completed
K.2 Ceiling fan (4pieces) Completed
K.3 Convinience outlets Completed
K.4 18 watts led light fixture with switches Installed
K.5 Emergency lights Installed
L. PLUMBING/ SANITARY WORKS
Installed
L.1 Wc Tank type Lever type Flush w/ complete fittings
and accessories
Lavatory complete with spray faucet, fittings and Installed/no P-trap
L.2 accessories

Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. Installed/no P-trap
L.3
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) Not Yet Installed
Installed
L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap)
(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted Installed
Hose Bibb( at right side of building beside the toilet) Installed
L.7

L.8 Soap Holder Not Yet Installed


L.9 Stainless steel grabrail at toilet Installed
L.10 Prefabricated Septioc Tank System Installed
Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer I Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
mitted: March , 2017

School Sites- Phase 1

EMARKS

ompleted

ompleted
ompleted

ompleted

ompleted

ompleted

pleted/Dirty

ompleted

ompleted
ompleted

ompleted
ompleted
et delivered
et delivered
et delivered
et delivered

ompleted

ompleted

m screen & locks are broken

uminum screen door

nstalled

int rusty square columns

ompleted

stable steel handrail @ ramp

ompleted
ompleted
ompleted
nstalled
nstalled

nstalled

ed/no P-trap

ed/no P-trap

Yet Installed
nstalled

nstalled
nstalled

Yet Installed
nstalled
nstalled
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2017 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Inanama Elementary School
SCHOOL CODE/ID 103015
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Alicia/Inanama
REGION II

ITEM NO. DESCRIPTION REMARKS


J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing Completed
J.1 bars
J.2 Tie beam Completed
4" floor slab on fill with 10mm dia. Reinforcing bars Completed
J.3
Concrete waiting area(4" thick reinforced concrete
with 12mm dia. Reinforcing bars at 600mm spacing Completed
J.4
bothways)
J.5 Concrete ramp Completed

A. FLOOR FINISHES
A.1 Floor Finishes Completed
B. WALLS
B.1 Wall Panels with Insulation Completed/Dirty
C. CEILING
C.1 Ceiling Panels Completed
D. FURNISHINGS
D.1 Reception Counter with chair(1) Completed
Health Worker's Counter with chair (1), visitor's Completed
D.2 chair(2)
D.3 Waiting Area - metal bench with rest(2) Completed
D.4 Examining bed(2) Completed
Nebulizer Not yet delivered
Non contact forehead thermometer Not yet delivered
Digital sphygmomanometer Not yet delivered
Dressing set Not yet delivered
E. COUNTERS AND CABINET WORKS, SIGNAGE
Completed
E.1
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) Completed
F. DOORS AND WINDOWS
Sliding glass windows on metalframe, with aluminum Installed/No aluminum screen & locks are broken
F.1
screen
Sttel Doors - entrance door with aluminum screen Installed/No aluminum screen door
F.2 door
F.3 Steel Doors - all interior doors Installed
G. PAINTING WORKS
G.3 PAINTING WORKS Completed/ Repaint rusty square columns
H. ROOFING WORKS WITH TRUSS / RAFTER
Completed
H.1 Ribbed, pre - painted metal galvanized Iron sheets
with steel rafters, with insulation
I. STAIRS/RAMP
50mm dia x 3.6m handrail, stainless steel for main Completed/ Repair unstable steel handrail @ ramp
I.1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits Completed
K.2 Ceiling fan (4pieces) Completed
K.3 Convinience outlets Completed
K.4 18 watts led light fixture with switches Installed
K.5 Emergency lights Installed
L. PLUMBING/ SANITARY WORKS
Installed
L.1 Wc Tank type Lever type Flush w/ complete fittings
and accessories
Lavatory complete with spray faucet, fittings and Installed/no P-trap
L.2 accessories

Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. Installed/no P-trap
L.3
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) Not Yet Installed
Installed
L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap)
(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted Installed
Hose Bibb( at right side of building beside the toilet) Installed
L.7

L.8 Soap Holder Installed


L.9 Stainless steel grabrail at toilet Installed
L.10 Prefabricated Septioc Tank System Installed
Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer I Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
mitted: March , 2017

School Sites- Phase 1

EMARKS

ompleted

ompleted
ompleted

ompleted

ompleted

ompleted

pleted/Dirty

ompleted

ompleted
ompleted

ompleted
ompleted
et delivered
et delivered
et delivered
et delivered

ompleted

ompleted

m screen & locks are broken

uminum screen door

nstalled

int rusty square columns

ompleted

stable steel handrail @ ramp

ompleted
ompleted
ompleted
nstalled
nstalled

nstalled

ed/no P-trap

ed/no P-trap

Yet Installed
nstalled

nstalled
nstalled

nstalled
nstalled
nstalled
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: March , 2017 Date Rectification Pictures Submitted: March , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Baleleng Elementary School
SCHOOL CODE/ID 103861
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Sto. Tomas/Baleleng
REGION II

ITEM NO. DESCRIPTION AS PER POW AS PER ACTUAL


QTY UNIT QTY UNIT
J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing
J.1 bars 1 lot lot

J.2 Tie beam 1 lot lot


4" floor slab on fill with 10mm dia. Reinforcing bars
J.3 50 sq.m sq.m
Concrete waiting area(4" thick reinforced concrete
J.4 with 12mm dia. Reinforcing bars at 600mm spacing 1 lot lot
bothways)
J.5 Concrete ramp 1 lot lot
A. FLOOR FINISHES
A.1 Floor Finishes 1 lot lot
B. WALLS
B.1 Wall Panels with Insulation 1 lot lot
C. CEILING
C.1 Ceiling Panels 1 lot lot
D. FURNISHINGS
D.1 Reception Counter with chair(1) 1 lot lot
Health Worker's Counter with chair (1), visitor's
D.2 chair(2) 1 lot lot

D.3 Waiting Area - metal bench with rest(2) 2 pcs pcs


D.4 Examining bed(2) 2 set set
E. COUNTERS AND CABINET WORKS, SIGNAGE
E.1 3 sets sets
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) 1 pc pc
F. DOORS AND WINDOWS

F.1 Sliding glass windows on metalframe, with aluminum 1 lot lot


screen
Steel Doors - entrance door with aluminum screen
F.2 door 1 lot lot

F.3 Steel Doors - all interior doors 1 lot lot


G. PAINTING WORKS
G.3 PAINTING WORKS 1 lot lot
H. ROOFING WORKS WITH TRUSS / RAFTER

H.1 Ribbed, pre - painted metal galvanized Iron sheets 1 lot lot
with steel rafters, with insulation
I. STAIRS/RAMP

I.1 50mm dia x 3.6m handrail, stainless steel for main 1 lot lot
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits 1 lot lot
K.2 Ceiling fan (4pieces) 4 sets sets
K.3 Convinience outlets 8 pcs pcs
K.4 18 watts led light fixture with switches 7 pcs pcs
K.5 Emergency lights 3 pcs pcs
L. PLUMBING/ SANITARY WORKS

L.1 Wc Tank type Lever type Flush w/ complete fittings 1 set set
and accessories
Lavatory complete with spray faucet, fittings and
L.2 accessories 1 set set

L.3 Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. 3 sets sets
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) 1 pc pc

L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap) 4 pcs pcs


(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted 1 pc pc
Hose Bibb( at right side of building beside the toilet)
L.7 1 pc pc

L.8 Soap Holder 1 pc pc


L.9 Stainless steel grabrail at toilet 1 lot lot
L.10 Prefabricated Septioc Tank System 1 lot lot

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer II Engineer III/RCWIO
VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV
Regional Director
mitted: March , 2017

School Sites- Phase 1

REMARKS

Completed

Completed
Completed

Completed

Completed

Completed

Completed/Dirty

Completed

Completed
Completed

Completed
Completed
Completed

Completed

Installed/No aluminum
screen & locks are
broken
Installed/No aluminum
screen door
Installed

Completed/ Repaint
rusty square columns
Completed

Completed/ Repair
unstable steel handrail @
ramp

Completed
Completed
Completed
Installed
Installed

Installed

Installed

Installed/no P-trap

Installed
Installed

Installed
Installed

Installed
Installed
Installed
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(  304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: April 7 , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Dagupan Elementary School
SCHOOL CODE/ID 103014
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Alicia/Dagupan
REGION II

ITEM NO. DESCRIPTION AS PER POW AS PER ACTUAL


QTY UNIT QTY UNIT
J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing
J.1 bars 1 lot lot

J.2 Tie beam 1 lot lot


4" floor slab on fill with 10mm dia. Reinforcing bars
J.3 50 sq.m sq.m
Concrete waiting area(4" thick reinforced concrete
J.4 with 12mm dia. Reinforcing bars at 600mm spacing 1 lot lot
bothways)
J.5 Concrete ramp 1 lot lot
A. FLOOR FINISHES
A.1 Floor Finishes 1 lot lot
B. WALLS
B.1 Wall Panels with Insulation 1 lot lot
C. CEILING
C.1 Ceiling Panels 1 lot lot
D. FURNISHINGS
D.1 Reception Counter with chair(1) 1 lot lot
Health Worker's Counter with chair (1), visitor's
D.2 chair(2) 1 lot lot

D.3 Waiting Area - metal bench with rest(2) 2 pcs pcs


D.4 Examining bed(2) 2 set set
E. COUNTERS AND CABINET WORKS, SIGNAGE
E.1 3 sets sets
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) 1 pc pc
F. DOORS AND WINDOWS

F.1 Sliding glass windows on metalframe, with aluminum 1 lot lot


screen
Steel Doors - entrance door with aluminum screen
F.2 door 1 lot lot

F.3 Steel Doors - all interior doors 1 lot lot


G. PAINTING WORKS
G.3 PAINTING WORKS 1 lot lot
H. ROOFING WORKS WITH TRUSS / RAFTER

H.1 Ribbed, pre - painted metal galvanized Iron sheets 1 lot lot
with steel rafters, with insulation
I. STAIRS/RAMP

I.1 50mm dia x 3.6m handrail, stainless steel for main 1 lot lot
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits 1 lot lot
K.2 Ceiling fan (4pieces) 4 sets sets
K.3 Convinience outlets 8 pcs pcs
K.4 18 watts led light fixture with switches 7 pcs pcs
K.5 Emergency lights 3 pcs pcs
L. PLUMBING/ SANITARY WORKS

L.1 Wc Tank type Lever type Flush w/ complete fittings 1 set set
and accessories
Lavatory complete with spray faucet, fittings and
L.2 accessories 1 set set

L.3 Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. 3 sets sets
w/ C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) 1 pc pc

L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap) 4 pcs pcs


(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted 1 pc pc
Hose Bibb( at right side of building beside the toilet)
L.7 1 pc pc

L.8 Soap Holder 1 pc pc


L.9 Stainless steel grabrail at toilet 1 lot lot
L.10 Prefabricated Septioc Tank System 1 lot lot

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer II Engineer III/RCWIO
VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV
Regional Director
School Sites- Phase 1

REMARKS

Completed

Completed
Completed

Completed

Completed

Completed

Completed

Completed

Completed
Completed

Completed
Completed
Completed

Completed

Installed/No aluminum
screen & locks are
broken
Installed/No aluminum
screen door
Installed

Completed/ Repaint
rusty square columns
Completed

Completed

Completed
Completed
Completed
Installed
Installed

Installed

Installed

Installed/no P-trap

Installed
Installed

Installed
Installed

Installed
Installed
Installed
MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(   304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: April 7 , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Imbiao Elementary School
SCHOOL CODE/ID 103631
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Roxas/Imbiao
REGION II

ITEM NO. DESCRIPTION AS PER POW AS PER ACTUAL


QTY UNIT QTY
J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing bars
J.1 1 lot 1

J.2 Tie beam 1 lot 1


4" floor slab on fill with 10mm dia. Reinforcing bars
J.3 50 sq.m 50
Concrete waiting area(4" thick reinforced concrete with
J.4 12mm dia. Reinforcing bars at 600mm spacing 1 lot 1
bothways)
J.5 Concrete ramp 1 lot 1
A. FLOOR FINISHES
A.1 Floor Finishes 1 lot 1
B. WALLS
B.1 Wall Panels with Insulation 1 lot 1
C. CEILING
C.1 Ceiling Panels 1 lot 1
D. FURNISHINGS
D.1 Reception Counter with chair(1) 1 lot 1
Health Worker's Counter with chair (1), visitor's chair(2)
D.2 1 lot 1

D.3 Waiting Area - metal bench with rest(2) 2 pcs 2


D.4 Examining bed(2) 2 set 2
E. COUNTERS AND CABINET WORKS, SIGNAGE
E.1 3 sets 3
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) 1 pc 1
F. DOORS AND WINDOWS

F.1 Sliding glass windows on metalframe, with aluminum 1 lot 1


screen
Steel Doors - entrance door with aluminum screen door
F.2 1 lot 1

F.3 Steel Doors - all interior doors 1 lot 1


G. PAINTING WORKS
G.3 PAINTING WORKS 1 lot 1
H. ROOFING WORKS WITH TRUSS / RAFTER
Ribbed, pre - painted metal galvanized Iron sheets with
H.1 steel rafters, with insulation 1 lot 1

I. STAIRS/RAMP

I.1 50mm dia x 3.6m handrail, stainless steel for main 1 lot 1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits 1 lot 1
K.2 Ceiling fan (4pieces) 4 sets 4
K.3 Convinience outlets 8 pcs 8
K.4 18 watts led light fixture with switches 7 pcs 7
K.5 Emergency lights 3 pcs 3
L. PLUMBING/ SANITARY WORKS

L.1 Wc Tank type Lever type Flush w/ complete fittings and 1 set 1
accessories
Lavatory complete with spray faucet, fittings and
L.2 accessories 1 set 1

L.3 Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. w/ 3 sets 3
C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) 1 pc 1

L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap) 4 pcs 4


(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted 1 pc 1
Hose Bibb( at right side of building beside the toilet)
L.7 1 pc 1

L.8 Soap Holder 1 pc 1


L.9 Stainless steel grabrail at toilet 1 lot 1
L.10 Prefabricated Septioc Tank System 1 lot 1

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer II Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
ORT

n Public School Sites- Phase 1

AS PER ACTUAL REMARKS


UNIT

Completed
lot

lot Completed
Completed
sq.m
Completed
lot

lot Completed

lot Completed

lot Completed

lot Completed

lot Completed
Completed
lot

pcs Completed
set Completed
Completed
sets

pc No DOH logo

Installed/No aluminum
lot screen & locks are broken
Installed/No aluminum
lot screen door
lot Installed

lot Completed

lot Completed

lot Completed

lot Completed
sets Completed
pcs Completed
pcs Installed
pcs Installed

Installed
set
Installed
set
Installed
sets

pc Installed
Installed/Floor Drain not
pcs connected to septic tank
pc Installed
Installed
pc

pc Installed
lot Installed
lot Installed
PEZ,MD,MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(   304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: April 7 , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL Luna - Rang ayan Elementary School
SCHOOL CODE/ID 103634
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Roxas/Luna
REGION II

ITEM NO. DESCRIPTION AS PER POW AS PER ACTUAL


QTY UNIT QTY
J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing bars
J.1 1 lot 1

J.2 Tie beam 1 lot 1


4" floor slab on fill with 10mm dia. Reinforcing bars
J.3 50 sq.m 50
Concrete waiting area(4" thick reinforced concrete with
J.4 12mm dia. Reinforcing bars at 600mm spacing 1 lot 1
bothways)
J.5 Concrete ramp 1 lot 1
A. FLOOR FINISHES
A.1 Floor Finishes 1 lot 1
B. WALLS
B.1 Wall Panels with Insulation 1 lot 1
C. CEILING
C.1 Ceiling Panels 1 lot 1
D. FURNISHINGS
D.1 Reception Counter with chair(1) 1 lot 1
Health Worker's Counter with chair (1), visitor's chair(2)
D.2 1 lot 1

D.3 Waiting Area - metal bench with rest(2) 2 pcs 2


D.4 Examining bed(2) 2 set 2
E. COUNTERS AND CABINET WORKS, SIGNAGE
E.1 3 sets 3
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) 1 pc 1
F. DOORS AND WINDOWS

F.1 Sliding glass windows on metalframe, with aluminum 1 lot 1


screen
Steel Doors - entrance door with aluminum screen door
F.2 1 lot 1

F.3 Steel Doors - all interior doors 1 lot 1


G. PAINTING WORKS
G.3 PAINTING WORKS 1 lot 1
H. ROOFING WORKS WITH TRUSS / RAFTER
Ribbed, pre - painted metal galvanized Iron sheets with
H.1 steel rafters, with insulation 1 lot 1

I. STAIRS/RAMP

I.1 50mm dia x 3.6m handrail, stainless steel for main 1 lot
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits 1 lot 1
K.2 Ceiling fan (4pieces) 4 sets 4
K.3 Convinience outlets 8 pcs 8
K.4 18 watts led light fixture with switches 7 pcs 7
K.5 Emergency lights 3 pcs 3
L. PLUMBING/ SANITARY WORKS

L.1 Wc Tank type Lever type Flush w/ complete fittings and 1 set 1
accessories
Lavatory complete with spray faucet, fittings and
L.2 accessories 1 set 1

L.3 Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. w/ 3 sets 3
C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) 1 pc 1

L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap) 4 pcs 4


(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted 1 pc 1
L.7 Hose Bibb( at right side of building beside the toilet) 1 pc 1
L.8 Soap Holder 1 pc 1
L.9 Stainless steel grabrail at toilet 1 lot 1
L.10 Prefabricated Septioc Tank System 1 lot 1

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer II Engineer III/RCWIO
VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV
Regional Director
ORT

n Public School Sites- Phase 1

AS PER ACTUAL REMARKS


UNIT

Completed
lot

lot Completed
Completed
sq.m
Completed
lot

lot Completed

lot Completed

lot Completed

lot Completed

lot Completed
Completed
lot

pcs Completed
set Completed
Completed
sets

pc Completed

Installed/No aluminum
lot screen & locks are broken
Installed/No aluminum
lot screen door
lot Installed

lot Completed

lot Completed

lot No Stair Constructed

lot Completed
sets Completed
pcs Completed
pcs Installed
pcs Installed

set Installed

set Installed

sets Installed

pc Installed

pcs Installed

pc Installed
pc Installed
pc Installed
lot Installed
lot Installed
PEZ,MD,MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(   304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: April 7 , 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL San Pablo Elementary School
SCHOOL CODE/ID 103016
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Alicia/San Pablo
REGION II

ITEM NO. DESCRIPTION AS PER POW AS PER ACTUAL


QTY UNIT QTY
J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing bars
J.1 1 lot 1

J.2 Tie beam 1 lot 1


4" floor slab on fill with 10mm dia. Reinforcing bars
J.3 50 sq.m 50
Concrete waiting area(4" thick reinforced concrete with
J.4 12mm dia. Reinforcing bars at 600mm spacing 1 lot 1
bothways)
J.5 Concrete ramp 1 lot 1
A. FLOOR FINISHES
A.1 Floor Finishes 1 lot 1
B. WALLS
B.1 Wall Panels with Insulation 1 lot 1
C. CEILING
C.1 Ceiling Panels 1 lot 1
D. FURNISHINGS
D.1 Reception Counter with chair(1) 1 lot 1
Health Worker's Counter with chair (1), visitor's chair(2)
D.2 1 lot 1

D.3 Waiting Area - metal bench with rest(2) 2 pcs 2


D.4 Examining bed(2) 2 set 2
E. COUNTERS AND CABINET WORKS, SIGNAGE
E.1 3 sets 3
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) 1 pc 1
F. DOORS AND WINDOWS

F.1 Sliding glass windows on metalframe, with aluminum 1 lot 1


screen
Steel Doors - entrance door with aluminum screen door
F.2 1 lot 1

F.3 Steel Doors - all interior doors 1 lot 1


G. PAINTING WORKS
G.3 PAINTING WORKS 1 lot 1
H. ROOFING WORKS WITH TRUSS / RAFTER
Ribbed, pre - painted metal galvanized Iron sheets with
H.1 steel rafters, with insulation 1 lot 1

I. STAIRS/RAMP

I.1 50mm dia x 3.6m handrail, stainless steel for main 1 lot 1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits 1 lot 1
K.2 Ceiling fan (4pieces) 4 sets 4
K.3 Convinience outlets 8 pcs 8
K.4 18 watts led light fixture with switches 7 pcs 7
K.5 Emergency lights 3 pcs 3
L. PLUMBING/ SANITARY WORKS

L.1 Wc Tank type Lever type Flush w/ complete fittings and 1 set 1
accessories
Lavatory complete with spray faucet, fittings and
L.2 accessories 1 set 1

L.3 Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. w/ 3 sets 3
C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) 1 pc 1

L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap) 4 pcs 4


(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted 1 pc 1
L.7 Hose Bibb( at right side of building beside the toilet) 1 pc 1
L.8 Soap Holder 1 pc 1
L.9 Stainless steel grabrail at toilet 1 lot 1
L.10 Prefabricated Septioc Tank System 1 lot 1

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer II Engineer III/RCWIO
VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV
Regional Director
ORT

n Public School Sites- Phase 1

AS PER ACTUAL REMARKS


UNIT

Completed
lot

lot Completed
Completed
sq.m
Completed
lot

lot Completed

lot Completed

lot Completed

lot Completed

lot Completed
Completed
lot

pcs Completed
set Completed
Completed
sets

pc Completed

Installed/No aluminum
lot screen & locks are broken
Installed/No aluminum
lot screen door
lot Installed

lot Completed

lot Completed

lot Completed

lot Completed
sets Completed
pcs Completed
pcs Installed
pcs Installed

set Installed

set Installed

sets Installed

pc Installed

pcs Installed

pc Installed
pc Installed
pc Installed
lot Installed
lot Installed
PEZ,MD,MPH,MHA,CESO IV
Republic of the Philippines
Department of Health
Regional Office II
Maharlika Highway, Carig Norte, Tuguegarao City
(   304-6585, 304-8737, 846-7261 & 846-7230
e-mail address: chdcvdoh@yahoo.com/dohregionaloffice2@gmail.com
TeleFax no. 304-6523 & 304-6734

SCHOOL BASE CLINIC INSPECTION REPORT

Date Inspected: April 7, 2017

PROJECT Construction of DOH-TSEKAP Health Stations in Public School Sites- Phase 1


NAME OF SCHOOL San Pedro Elementary School
SCHOOL CODE/ID 103017
PROVINCE/MUNICIPALITY/BARANGAY Isabela/Alicia/San Pedro
REGION II

ITEM NO. DESCRIPTION AS PER POW AS PER ACTUAL


QTY UNIT QTY
J. STRUCTURAL
Footing and fabrication with 16mm dia. Reinforcing bars
J.1 1 lot 1

J.2 Tie beam 1 lot 1


4" floor slab on fill with 10mm dia. Reinforcing bars
J.3 50 sq.m 50
Concrete waiting area(4" thick reinforced concrete with
J.4 12mm dia. Reinforcing bars at 600mm spacing 1 lot 1
bothways)
J.5 Concrete ramp 1 lot 1
A. FLOOR FINISHES
A.1 Floor Finishes 1 lot 1
B. WALLS
B.1 Wall Panels with Insulation 1 lot 1
C. CEILING
C.1 Ceiling Panels 1 lot 1
D. FURNISHINGS
D.1 Reception Counter with chair(1) 1 lot 1
Health Worker's Counter with chair (1), visitor's chair(2)
D.2 1 lot 1

D.3 Waiting Area - metal bench with rest(2) 2 pcs 2


D.4 Examining bed(2) 2 set 2
E. COUNTERS AND CABINET WORKS, SIGNAGE
E.1 3 sets
Counter cabinets including hardwares and accessories
E.2 Signage(600mm x 800mmacrylic) 1 pc 1
F. DOORS AND WINDOWS

F.1 Sliding glass windows on metalframe, with aluminum 1 lot 1


screen
Steel Doors - entrance door with aluminum screen door
F.2 1 lot 1

F.3 Steel Doors - all interior doors 1 lot 1


G. PAINTING WORKS
G.3 PAINTING WORKS 1 lot 1
H. ROOFING WORKS WITH TRUSS / RAFTER
Ribbed, pre - painted metal galvanized Iron sheets with
H.1 steel rafters, with insulation 1 lot

I. STAIRS/RAMP

I.1 50mm dia x 3.6m handrail, stainless steel for main 1 lot 1
entrance ramp
K. ELECTRICAL WORK
K.1 Electrical wires and conduits 1 lot 1
K.2 Ceiling fan (4pieces) 4 sets 4
K.3 Convinience outlets 8 pcs 8
K.4 18 watts led light fixture with switches 7 pcs 7
K.5 Emergency lights 3 pcs 3
L. PLUMBING/ SANITARY WORKS

L.1 Wc Tank type Lever type Flush w/ complete fittings and 1 set 1
accessories
Lavatory complete with spray faucet, fittings and
L.2 accessories 1 set 1

L.3 Wash Sink with counter Ga. Steel 25 x 16 x 6in comp. w/ 3 sets 3
C-spout faucet and accessories
L.4 Face Mirror ( 500mmx 600mm x 6mm ) 1 pc 1

L.5 Floor Drains( Stainless Steel(S.S.) withwaterless trap) 4 pcs 4


(toilet, and under all sinkcounters)
L.6 Tissue Paper Holder Wall Mounted 1 pc 1
Hose Bibb( at right side of building beside the toilet)
L.7 1 pc 1

L.8 Soap Holder 1 pc 1


L.9 Stainless steel grabrail at toilet 1 lot 1
L.10 Prefabricated Septioc Tank System 1 lot 1

Prepared/Validated by: Noted by:

JOHNSER A. ALVAREZ VICTORINO F. MANINGAS


Engineer II Engineer III/RCWIO

VALERIANO JESUS V. LOPEZ,MD,MPH,MHA,CESO IV


Regional Director
ORT

n Public School Sites- Phase 1

AS PER ACTUAL REMARKS


UNIT

Completed
lot

lot Completed
Completed
sq.m
Completed
lot

lot Completed

lot Completed

lot Completed

lot Completed

lot Completed
Completed
lot

pcs Completed
set Completed
no Curtain
sets

pc Completed

Installed/No aluminum
lot screen & locks are broken
Installed/No aluminum
lot screen door
lot Installed

lot Completed

Incomplete Roof
lot Flashing(almost 10 l.m.)

Completed
lot

lot Completed
sets Completed
pcs Completed
pcs Installed
pcs Installed

Installed
set
Installed
set
Installed
sets

pc Installed
Installed/Floor Drain not
pcs connected to septic tank
pc Installed
Installed
pc

pc Installed
lot Installed
lot Installed
PEZ,MD,MPH,MHA,CESO IV